Sequential boost in neoadjuvant irradiation for T3N0-1 rectal cancer: long-term results from a single-center experience



To evaluate the influence of radiation dose on tumor regression grade (TRG) and sphincter preservation rate in a series of cT3N0-1 rectal cancer patients treated with neoadjuvant chemoradiotherapy (CT-RT) with or without a sequential radiation boost.

Materials and methods

Between May 2002 and September 2013, 116 cases were eligible for retrospective evaluation. Radiotherapy was delivered for a total dose of 45 Gy (no boost arm) or 50.4 Gy (boost arm). TRG was evaluated with the Dworak scale.


Median follow-up was 62 months (range, 12-138 months). The 5-year overall survival and local control rates were 72% and 93%, respectively. Fifty-five patients (47%) were treated with a sequential radiation boost and 61 (53%) without a boost. Eighty patients (72%) presented T3N0 disease and 32 (28%) T3N1 disease. Concomitant capecitabine was administered in 92 cases (79%) and intravenous 5-fluorouracil in 24 cases (21%). Sphincter preservation was performed in 82% of patients in the boost arm and 66% in the no-boost arm. A higher TRG was related to a longer interval between neoadjuvant treatment and surgery (p<0.001). The probability of a TRG ≥2 was 2.5 times higher in the boost arm. A gain in local control, estimated at 4% during the first 3 years after CT-RT, favored the boost arm.


The long-term results from our single-center experience confirm literature data on the role of a sequential boost in tumor response after neoadjuvant CT-RT in a series of cT3N0-1 rectal cancer patients.

Tumori 2016; 102(3): 316 - 322




Rosario Mazzola, Giuseppe Ferrera, Teresa Cucchiara, Vanessa Figlia, Marina Gueci, Francesco Sciumè, Gioacchino Di Paola, Nunzia Scibetta, Antonio Lo Casto, Maria Pia Pappalardo, Roberto Lagalla, Filippo Alongi

Article History


Financial support: None.
Conflict of interest: The authors have no conflict of interest to declare.

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  • Radiation Oncology School, University of Palermo, Palermo - Italy
  • Radiation Oncology, Sacro Cuore Don Calabria Hospital, Negrar-Verona - Italy
  • Radiation Oncology, ARNAS Hospital, Palermo - Italy
  • Statistic Sciences Faculty, University of Palermo, Palermo - Italy
  • Pathology Unit, ARNAS Hospital, Palermo - Italy
  • Sezione di Scienze radiologiche, DIBIMEL, University of Palermo, Palermo - Italy

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